Nedim Yılmaz Selçuk

The Relationship between Oxidative Stress, Inflammation, and Atherosclerosis in Renal Transplant and End-Stage Renal Disease Patients

Objectives: Cardiovascular risk is increased in the early stages of chronic kidney disease (CKD) and is also found to be ongoing in renal transplant (Rtx) patients. As a sign of atherosclerosis, increased carotid intima–media thickness (CIMT) has been widely accepted as a strong predictor of cardiovascular disease (CVD) and mortality in the end-stage renal disease (ESRD) patients. Ischemia-modified albumin (IMA), pentraxin-3 (PTX-3), and neutrophil-to-lymphocyte ratio (NLR) were introduced as oxidative stress and inflammatory biomarkers in ESRD. The role of Rtx in terms of atherogenesis, oxidative stress, and inflammation is still unclear. We aimed to investigate the relationship between IMA, PTX-3, NLR, and CIMT in Rtx patients without overt CVD and to compare these results with those obtained from healthy subjects and ESRD patients receiving hemodialysis (HD) and peritoneal dialysis (PD). Design and methods: Cross-sectional analysis in which CIMT measurements, NLR, and serum PTX-3 and IMA levels were assessed in 18 Rtx patients (10 females; mean age: 40.0 ± 13.3 years), 16 PD patients (7 females; 40.2 ± 12.9 years), 14 HD patients (8 females; 46.6 ± 10.7 years), and 19 healthy subjects (9 females; 36.9 ± 8.9 years). Results: IMA, PTX-3, and high-sensitive C-reactive protein (hs-CRP) levels, NLR, and CIMT of Rtx patients were found to be significantly higher compared with healthy subjects ( p = 0.04, p < 0.0001, p < 0.005, p = 0.005, and p = 0.005, respectively). IMA level was positively correlated with hs-CRP and PTX-3 levels, NLR, and CIMT when all participants were included (r = 0.338, p = 0.005; r = 0.485, p < 0.0001; r = 0.304, p = 0.013; and r = 0.499, p < 0.0001, respectively). Conclusion: There has been ongoing inflammation, oxidative stress, and atherosclerosis in Rtx patients.

Changes in frequency and etiology of acute renal failure in pregnancy (1980 – 1997)

In recent years, the incidence of acute renal failure (ARF) in pregnancy has decreased in developed countries. This cause of this decline has been reported to be liberalized abortion laws and improved prenatal care. The aim of this study was to determine if the incidence and etiology of ARE in pregnancy in our population had undergone similar changes. Between January 1, 1980 and January 1 1997 the number of the patients with ARF was 487. In 74 (15%) of these patients, the etiology of ARF was associated with pregnancy. The frequency of ARF in pregnancy was 17.4% between January 1980 and August 1985, 15.4% between September 1985 and November 1989, 13.5% between December 1989 and January 1997. The differences between the frequencies were not statistically significant (p > 0.5). In the present series, the various disorders leading to ARF in pregnancy were abortion (30%), HELP syndrome and pre-eclampsia (14%), pre-eclampsia or eclampsia (12%), postpartum hemorrhage (15%), fetal death (12%), abruption placentae (6%) and placentae previa (1%).

Genotype–Phenotype Correlation in Patients with Familial Mediterranean Fever in East Anatolia (Turkey)

AIMS Familial Mediterranean fever (FMF) is an autosomal recessive hereditary disease. Clinical symptoms and findings (phenotypes) seen in this disease are generally fever, abdominal pain, and arthritis. Amyloidosis is also a significant complication. Phenotype-genotype correlations in FMF have not been conclusively resolved. The aims of this study were to find the most frequent mutation/genotype of FMF, as well as to investigate the role of genetic factors on the phenotype and on the development of amyloidosis in a population living in East Anatolia (Turkey). This study included 105 adult patients with FMF. DNA samples were obtained from peripheral blood lymphocytes of the patients. Mutations of the Mediterranean fever (MEFV) gene were analyzed with an FMF Strip Assay test kit (ViennaLab Labordiagnostika GmbH, Vienna, Austria). Patients were separated according to genotypes, and phenotypes were compared statistically by the chi-square test. RESULTS The most frequent mutation was M694V (53%) and the most frequent genotype was M694V/M694V (26%). In total, 81% of the patients experienced abdominal pain, 76% had fever, and 22% had arthritis. Fever and arthritis were determined in similar ratios to other genotypes (76% and 19%, respectively) in the M694V/M694V genotype (74% and 29%, respectively) (p > 0.50 and p > 0.20, respectively). However, the patients without the M694V/M694V genotype (86%) had a higher abdominal pain ratio than did the patients with the M694V/M694V genotype (67%) (p <0.05). Renal amyloidosis was determined in 33% of both M694V/M694V and M680I(G/C)/M680I(G/C) homozygous groups and in 12% of the heterozygous groups (p < 0.02 and p < 0.00002, respectively). In other words, homozygous groups had higher ratios of renal amyloidosis. CONCLUSIONS The most frequent mutation in FMF was M694V and the most frequent genotype was M694V/M694V. Fever, abdominal pain, arthritis, and renal amyloidosis were determined not only in patients with M694V/M694V genotype but also in other genotypes. Therefore, genotypes may not predict phenotypes in FMF. Renal amyloidosis was seen more frequently in homozygous genotypes.

THE IMPORTANCE OF SERUM TRANSFERRIN RECEPTOR LEVEL IN THE DIAGNOSIS OF FUNCTIONAL IRON DEFICIENCY DUE TO RECOMBINANT HUMAN ERYTHROPOIETIN TREATMENT IN HAEMODIALYSIS PATIENTS

In haemodialysis (HD) patients, functional iron deficiency frequently appears due to recombinant human erythropoietin (r-HuEPO) treatment. However, the diagnosis of iron deficiency is not always easy in such patients. Recent studies have shown that the serum transferrin receptor (s-TfR) level is a sensitive, quantitative measure of tissue iron deficiency. In this study, we examined the changes in s-TfR levels in patients with iron deficiency anaemia due to r-HuEPO treatment.We compared s-TfR levels of 24 patients with i.v. administered r-HuEPO 50–70 U/kg/dose) at the end of each dialysis session (three times a week) and diagnosed as having iron deficiency anaemia by routine laboratory methods (ferritin<50 μg/l and transferrin saturation<16%) with s-TfR levels of 32 patients not receiving r-HuEPO and without iron deficiency anaemia. Also, 40 healthy volunteer subjects were included in the study as a control group. Serum ferritin and transferrin receptor levels were measured with ELISAs using monoclonal reagents. There were no differences between the two groups with and without iron deficiency anaemia with respect to mean age, body weight, haemodialysis duration, haemoglobin and serum creatinine levels (p>0.05). For s-TfR levels, while no difference was present between the control and the non-iron deficiency groups (p>0.05), the iron deficiency group had higher s-TfR values than those of both the control and non-iron deficiency groups (p<0.001). Besides, there was an inverse correlation between haemoglobin and s-TfR levels in patients with iron deficiency anaemia (r=−0.85, p<0.0001).We conclude that the measurement of s-TfR levels may be useful in the diagnosis of functional iron deficiency in haemodialysis patients receiving r-HuEPO.

Frequency and outcome of patients with acute renal failure have more causes than one in etiology

In literature, there was little data about frequency and outcomeof ARF with two or more causes in etiology. Therefore, the aim of this studywas to search this issue. This series included 339 patients with ARF from Jan 1,1987 to Jan 1,1999.Fourty-six (30 males) of all patients (13.5%) had two or more causes in etiologyof ARF. Of these patients, causes were prerenal and renal in 26 (56%), prerenal,renal and postrenal in 12 (26%), renal and postrenal in 4 (9%), and prerenaland postrenal in 4 (9%). The most frequent cause is diarrhea and vomitingin prerenal, gentamycin usage in renal and prostat hypertrophy in postrenal.Of these patients, there was oliguria in 32 (70%), anuria in 8 (17%) and non-oliguriain 6 (13%). Treatment modalities of patients was only medical in 19 (41%),dialysis in addition to medical therapy in 27 (59%). In spite of treatment,5 (10.8) of patients with two or more causes in etiology died. Causes of deathwere uremic coma in 2, cardiac disorders in 2 and septic shock in 1. Three(11.2%) of other patients with one cause died. Mortality rates were not different(χ2: 0.0298, p> 0.5). Cortical necrosis was diagnosed in one patient with multiplee etiologyand 2 of other patients. Finally, frequency of ARF with two or more etiologic causes was 13.5%,and most frequent causes were hypovolemia and nephrotoxic drugs. Outcome ofthese patients was similar to other patients with one cause.

Common variable immunodeficiency in adults requires reserved protocols for long-term follow-up

BACKGROUND/AIM The aim of this study is to establish follow-up protocols for adult patients with common variable immunodeficiency (CVID) in a recently founded adult immunology clinic in the Central Anatolia Region of Turkey, where a clinical immunology center for adults was not available previously. MATERIALS AND METHODS A total of 25 patients with CVID aged 18 years and older were included in this study. The file format consisted of 13 pages and was developed for the purpose of the study. Separate sections were designated for identity information, medical history, disease course, previous and current laboratory and imaging studies, follow-up plans, detection and management of complications/comorbidities, and treatment results. RESULTS The mean age of the patients was 36.6 ± 13.4 years. The delay in diagnosis was 107 ± 95.6 months. In 92% of patients, initial symptoms resulting in admission to healthcare facilities were infections. Seventeen of 25 patients (68%) had bronchiectasis at the beginning of follow-up. CONCLUSION Early identification of complications and comorbidities in patients with CVID will significantly improve quality of life and survival. Close observation and standardized protocols for follow-up are essential components of management.

Constrictive calcific pericarditis masked by haemodialysis

We admitted a maintenance haemodialysis patient with hypotension and weakness. He had undergone cadaveric renal transplantation 19 years earlier. He had lost his kidney due to chronic allograft nephropathy 1 year after transplantation and returned to haemodialysis. He had hypotension, especially remarkable during haemodialysis. He also had hepatitis C but no cirrhosis. The patient denied a previous pulmonary tuberculosis. On physical examination, he was hypotensive (80/60 mmHg) but without peripheral oedema, neck vein distention or hepatomegaly. Heart sounds were weakly heard and there was no audible murmur or friction rub. Pericardial calcification was noticed on chest x-ray (Figure ​(Figure1).1). Echocardiography could not visualize the pericardium or heart. Only coarse calcification of the pericardium from the subphrenic angle, but no further detail, was visible. Subsequently, we performed computerized tomography of the pericardium (Figure ​(Figure2),2), which revealed a crescent-like calcification of the pericardium. There were calcific plaques on the right lower lobe of the pulmonary pleura as well. Fig. 1 Postero-anterior chest x-ray showing crescent-like pericardial calcification. Note also that calcification in the pleura overlying right lower lung. Fig. 2 Coronal section of computerized tomography of the chest depicting crescent-like calcification of the pericardium encasing heart and right lower pleural calcification. The presence of pericardial calcification strongly suggests constrictive pericarditis (CP) in patients with symptoms and signs of heart failure. A myriad of disease states can cause pericardial calcification. In the Western world, the most common cause is idiopathic. However, in the developing countries, tuberculosis remains an important cause. Plain chest radiographs can display calcification. Echocardiography may confirm the diagnosis, showing a thickened pericardium and calcification in some cases. However, normal echocardiography does not rule out CP. Transoesophageal echocardiography is more sensitive; however, the gold standard for diagnosis is invasive haemodynamic evaluation. Patients with CP may present with two types of complaints: those related to fluid overload, ranging from peripheral oedema to anasarca; and those related to a diminished cardiac output response to exertion, such as fatiguibility and dyspnoea. These symptoms may be masked in haemodialysis patients due to ultrafiltration and close volume regulation. Conflict of interest statement. None declared.

Effects of a Normalized Protein Catabolism Rate on Platelet Functions in Non-Dialyzed Uraemic Patients

NPCR (p < 0.001, p < 0.001), lower platelet adhesion rates (p < 0.001, p < 0.001) and a more prolonged bleeding time (p < 0.05, p < 0.01) than the other groups. The patients in the high-BMI group had a lower NPCR than the normal-BMI group (p < 0.01), and their ADP-, epi-nephrine, ristocetin- and collagen-stimulated mean percent platelet aggregation values were higher than those of the low-BMI group (p < 0.01, p < 0.0001, p < 0.01, p < 0.01, respectively) and than those of the normal-BMI group for only epinephrine, ristocetin and collagen (p < 0.001, p < 0.05, p < 0.05, respectively). In low-BMI patients, ADPand epinephrine-stimulated percent aggregation values were lower than those of the nor-mal